Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD16577 | OR |
NPI | 1770581415 |
---|---|
Provider Name | Jeffrey Arthur Holmboe |
First Address | Bend, OR 97701-3887 |
Second Address | Bend, OR 97701-3887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 02/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013552 | (05) | OR |
E57551 | (02) |